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Biosimilar Adoption Within the Oncology Industry

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How the AON Pharmacy Operations team is increasing the usage of biosimilars as treatments for cancer patients.  

Back in September 2017, the U.S. Food and Drug Administration (FDA) approved the first biosimilar used for cancer treatments. Mvasi was created as the biosimilar alternative to the brand medication Avastin, which is used to treat various cancers. From colorectal and lung cancers to kidney cancer and brain cancer, Mvasi’s formulation was determined biosimilar when treating these cancers. Since 2017, over twenty biosimilars for cancer treatments have been approved.

The growth within the biosimilar market increases with the acceptance and adoption of these prescription alternatives by oncologists and other healthcare leaders who are taking the initiative to improve cost-savings for millions of cancer patients. AON is one such organization that is taking the lead to publicize the benefits — including the cost savings — of biosimilars..

Related: Understanding Biosimilars

AON’s Biosimilar Substitution Program

The biosimilar substitution program, the brainchild of the AON Pharmacy Operations team, was created to encourage the use of biosimilar products when a biosimilar is covered by the payer and the cost is lower, as an effective cost-saving strategy without negatively impacting the efficacy of the patient’s treatment.

By definition, a biosimilar is highly similar to and has no clinically meaningful differences from its reference product with cost-saving potential. A biosimilar is approved by the U.S. Food and Drug Administration (FDA) after rigorous evaluation and testing to show the same efficacy and same safety profile when compared to its reference product.  Expanding access to biosimilars can help to improve health equity and provide more treatment options for patients.

Acquiring biosimilar products can be challenging for various reasons. One of the more common barriers is health insurance coverage and requirements as it varies from state to state as well as how the insurer’s formulary is designed. While these hindrances may slow adoption, the AON Pharmacy Operations team recognizes the benefits of biosimilar products to not only the patient but to the healthcare provider and health insurer.

The switching model employs key persons within the process and equips them with the processes and tools needed to communicate and drive forward biosimilar substitutions. Originally, AON regional clinical pharmacists (RCPs) assisted in biosimilar product selection. Under the new biosimilar substitution program, the RCPs transitioned into an intermediary position between the pharmacy, healthcare providers, administrators and financial teams at each practice. Using the electronic health record (EHR) system empowers RCPs to communicate directly with financial teams and send switch requests (requests to switch to a biosimilar product) directly to the healthcare provider who can easily approve within the system.

The AON Pharmacy Operations team measured the impact of the program for one year and reported positive results:

  • There was an increase in all AON-preferred biosimilar products after program implementation. The total number of biosimilars now in use is 17.
  • The average in the United States for biosimilar usage is 65% whereas AON sits comfortably 20% higher.
  • There was an increase in cost savings for healthcare providers, payers and patients totaling $56.21 million for 2022 and $131.32 million since AON’s inception.

The AON Pharmacy Operations team hopes that sharing the program’s successes will encourage other clinicians and those in healthcare to switch and use biosimilars when appropriate.

Related: Expanding Options: What’s Next for Biosimilars in Oncology?

Addressing the Financial Concerns of Cancer Treatment

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Stress can have an adverse effect on a patient’s cancer treatment. It can weaken the immune system, increase bone pain and exacerbate fatigue. In some cases, the presence of stress can cause a relapse for those whose cancer had been in remission.

That is why, as they embark on the most frightening and worrisome time of their lives, cancer patients shouldn’t have to worry about money. But the reality is that cancer treatments can prove costly, especially if patients must travel far for treatment or are prescribed expensive medications. And that financial burden can create enormous stress.

At Hematology Oncology Clinic (HOC), we do what we can to ease the financial burden borne by our patients to help ensure they are not endangering their health by delaying care, skipping treatments or failing to refill their prescriptions—all of which adds to the stress generated by financial concerns.

Educating Our Patients

Rather than surprising patients with unexpected costs in the middle of treatments, we have them meet with one of HOC’s financial counselors at the outset to go over all pertinent financial information. We review their insurance plans to determine how much will be covered and, when necessary, we connect them with financial assistance and even free medications.

HOC has a five-person staff dedicated to helping patients ease financial concerns by tapping into a myriad of programs designed to help patients who need assistance covering treatment costs. With a decade of experience, our financial support team is intimately familiar with programs that most people aren’t aware even exist, such as grants that can help with copays and assistance programs through non-profit organizations and societies. Drug companies will also supply medications at no cost to patients who meet certain criteria.

We also encourage our patients to call us with any questions about their health rather than rushing to the emergency room when the situation isn’t life-threatening. Avoiding an unnecessary trip to the ER can save them thousands of dollars.

Another aspect of treatment costs is the type of practice a patient chooses for their oncology care. Community-based practices such as HOC can be up to 40% cheaper than hospital-based in- or outpatient programs.

The Financial Benefits of Joining a Network

One of the reasons HOC can help its patients ease financial concerns is its partnership with American Oncology Network (AON). Since joining in September 2018, we’ve seen our costs go down. The power of having a network behind us has opened doors to which a practice our size typically doesn’t have access. This has allowed us to get medications at much lower rates, a savings we can pass along to our patients.

With the help of AON and the willingness of various assistance programs to work with such a network, we were able to access $8.2 million over the past 18 months to help our patients, with about $6 million coming from grants. We were even able to help one of our patients reduce their copay to $0.

Through its participation in the Oncology Care Model, AON has been able to provide our patients with care managers to guide them through the process, including helping determine if a trip to the ER is necessary. This has helped cut out unwarranted expenses. And, because they are in regular communications, our patients feel comfortable calling them with questions rather than racking up extra costs that come from ER and hospital visits.

At HOC we strive to provide the best possible patient experience—providing compassionate and supportive cancer care, close to home. AON’s focus is on keeping community oncology alive, maintaining practice independence and serving patients outside hospital settings. Like us, their whole focus is the care of oncology patients.

AON’s philosophy aligns with ours: Putting the patient first. Through our partnership, we continue providing top-shelf care to our patients without adding unnecessary costs—and stress—at an already stressful time.

Cancer Care Cost

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Cancer is one of the leading causes of death and disease in the U.S. Not only does cancer take an enormous toll on the health of patients and survivors—it also has a tremendous financial impact. Cost differences associated with oncology care in the community setting versus a hospital setting are significant with community oncology practices providing high quality, state-of-the-art care at lower costs to patients.

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Expanding Options: What’s Next for Biosimilars in Oncology?

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The COVID-19 pandemic has negatively impacted industries worldwide, and healthcare has not been immune. Oncology practices in particular are looking to recoup dollars lost to a decline in patient visits and, as the economy weakens and unemployment rises, patients are looking for financial assistance and relief from high-cost medications.

The current environment could lead to a spike in biosimilar use, which can increase economic efficiency without sacrificing patient safety and satisfaction. But oncology practices should not view biosimilars as just a temporary alternative. Rather, these options could become part of the ongoing strategy long after the intensity of the pandemic wanes and the economy rights itself.

And while they offer plenty of advantages for practices and patients, working with biosimilars can be complex and may require the need of a partner to help streamline the process.

The Positives of Biosimilars

The biggest advantage of biosimilars is the savings, with some priced at 20% to 40% lower than the existing reference product. Those prices will continue to decrease as the market becomes more saturated, increasing competition.

Biosimilars go through a different regulatory pathway to demonstrate similarity to a reference product. The FDA’s determination of biosimilarity is based on the totality of the evidence, which includes an extensive analytical comparison to show that the proposed biosimilar and reference products are highly similar in structure and function. Animal, human pharmacologic, immunologic and additional clinical data are added as needed to the analytical data in a stepwise fashion. This allows for a shorter approval time and lower costs to develop a product with no meaningful clinical difference.  

Consequently, oncologists can trust that there is no drop in the effectiveness and safety of the biosimilar drug while realizing the cost advantages for both the practice and patients.

Economically, oncologists benefit because the reimbursement for biosimilars is based on the average sales price plus 6% of the reference product, leading to small incremental profits for the practice. Because biosimilars are cheaper in cost, that eventually leads to savings on out-of-pocket costs for the patient.

The Need for a Network

While working with biosimilars can yield positive results, they also come with their own set of complexities that some independent practices may not have the bandwidth or expertise to handle.

Payer formularies vary widely as they relate to biosimilars. While one insurer may approve one biosimilar for specific indications, another may use a different one. Keeping up with these formulary variances is a daunting task for the average resource-strapped oncology practice; many either avoid using biosimilars or find themselves stuck in the administrative back and forth of claims denials.

American Oncology Network (AON) improves this outlook for its practice network through management and oversight of approved biosimilars. Our team keeps physicians current on formularies by insurer, streamlining processes and improving cash flow for practices and patients alike.

In addition, AON offers better buying and negotiating power, which leads to the purchase of more economical biosimilars. From an operational standpoint, AON alleviates a practice’s operational burdens by taking care of the drug purchasing and contracts.

If patients are wary about biosimilars, AON’s board-certified oncology pharmacists can assist in putting their minds at ease. Many independent practices lack the resources or manpower to create promotional collateral, instead relying on materials provided by the manufacturer—many of whom have had to shut down promotional departments due to COVID-19. AON can help educate patients on biosimilars with informative literature that is thorough but also written on a level that consumers can easily digest.

Cancer patients are dealing with enough stress – the last thing they need to do is worry about the safety and efficacy of their medications. Our team ensures patients know that biosimilars have the same potency, purity and safety as the reference medications.

The New Standard

The current global pandemic has underscored the clinical and financial advantages of biosimilars. Oncology practices should also consider how they may benefit from their use after the COVID-19 crisis is over.

By leaning on established networks such as AON to ease administrative burdens associated with using biosimilars, oncology practices can realize the benefits of expanded options for themselves and the patients in their care.